7 per 1 000 person-years in Brazil and 3.2 per 1 000

person-years in India.12,24 Impact of Alzheimer’s disease at individual and societal levels At the individual level, AD significantly shortens life expectancy and is one of the principal causes of physical disability, institutionalization, and decreased quality of life among the elderly. First, AD is Inhibitors,research,lifescience,medical strongly associated with functional disability and institutionalization. It is estimated that among individuals over 60 years of age dementia contributes 11.2 % of the years lived with disability, compared with 9.5 % for stroke, 8.9 % for musculoskeletal disorders, and 5.0 % for cardiovascular disease.25 The follow-up studies of people, aged 75+ years in Sweden have shown that approximately Inhibitors,research,lifescience,medical half of the elderly people who develop functional dependence over a 3-year period can be attributable to dementia and AD.26 In many industrialized countries, dementia is the most common disease among older adults living in nursing homes or in institutions. Second, epidemiologic studies have confirmed the malignant nature of AD that could Inhibitors,research,lifescience,medical confers an excess risk of death for older people, in a similar extent to that of malignant tumors.27 Several

community-based follow-up studies of incident cases showed that AD was associated with a twoto fivefold increased risk of death.28,29 The long-term follow-up study also showed that AD was associated with relative risk of 2.6 for mortality, although the strength of association Inhibitors,research,lifescience,medical was diluted after controlling for multimorbidities.30 Overall, the median survival time for people with newly diagnosed AD ranges from 3 to 6 years.28 Older age, male sex, white race, low education, selleck kinase inhibitor comorbidities (eg, hypertension, diabetes, and heart disease), poorer cognitive function, and physical disability are frequently reported to predict a shorter survival in persons with AD.28-32 The rapid increase in the number of patients with dementia and AD will result in tremendous consequence for our society and economy. The number of persons with AD in the US population in 2000 was estimated to be 4.5 million, and by 2050 this

number Inhibitors,research,lifescience,medical was projected to increase by almost threefold, to 13.2 million.33 The more recent study indicated only that in 2006 the worldwide total number of patients with AD was 26.6 million, and by 2050 the number will quadruple.7 It was estimated that about 43 % of AD patients require a high level of care such as nursing home and institutions. The long-term institutional care will be the main cost in many developed countries, whereas in developing countries informal home care provided byfamily members is usually the only source available for patients with dementia.12 Even in the US, almost 10 million Americans (eg, family members, friends, and neighbors) provided unpaid care for persons with AD or other dementia.34 Thus, enormous resources will be needed for adequate care of Alzheimer and dementia patients.